Virtua Health is a five-hospital health system with more than 270 locations in Southern New Jersey. Virtua’s Community Health Needs Assessment has been performed every three years since 2013 and has identified access to care needs in the community, including transportation barriers to medical appointments.

THE PROBLEM

An evaluation of the food pantry program at the main hospital found that 60% of patients “sometimes,” “often” or “always” missed a medical appointment due to lack of transportation; one in five reported walking or a bus as the source of transportation to their appointment.

Missed appointments are associated with increased costs, disruption of care and provider-patient relationships, reduced use of primary care services, and increased emergency department visits.

In fact, one study found that transportation barriers account for approximately 3.6 million patient no-shows each year, which cost the healthcare industry $150 billion, said Dr. Bageshree Cheulkar, senior project manager for transportation at Virtua Health.

"The platform identifies the right vehicle and driver to meet the needs of any clinical use case."

Dr. Bageshree Cheulkar, Virtua Health

“Although Virtua has always offered transportation assistance to our patients as a community benefit, our previous means of transportation assistance was through cab and bus vouchers for ED and inpatients,” she explained. “But buses only run in limited areas, and we had problems communicating with cab companies – plus they don’t offer weekend service.”

A lack of transportation options led to backups in the ED and hospital, where discharged patients waiting for a ride home held up the transfer of beds to incoming patients. It took four to eight hours for a cab to pick up a patient from the ED. Virtua needed a more reliable, consistent way to coordinate transportation, and it wanted to provide help for the outpatient setting, as well, to address the health needs identified in the CHNAs.

PROPOSAL

Ride Health promoted its cloud-based and mobile-enabled transportation coordination platform as coordinating the entire ride experience, from creating personalized patient profiles in a HIPAA-compliant manner, to segmenting ride activities and billing by program, case-management group or patient population.

“The company partners with a variety of transportation providers, such as Uber, Curb and local operators, to meet every patient’s unique needs: on-demand, curb-to-curb, door-to-door, wheelchair accessible, stretchers, ambulances and more,” Cheulkar said. “Their platform engine distributes trips to transportation partners based on ride cost, past on-time performance, member satisfaction, client preference and demand-response time.”

Virtua staff can schedule rides for planned appointments or on-demand for unanticipated needs after an ED visit. For planned appointments, once rides are scheduled, patients can communicate with Ride Health via the channel they prefer most, whether text message, mobile phone, landline or an online portal. All Ride Health interactions are supported by real-time communication and translation in more than 100 languages.

“Unlike traditional nonemergency medical transportation solutions, which address problems with rides only hours after a ride is completed or missed, Ride Health’s platform monitors each ride throughout the trip for potential disruptions, such as late drivers or missed connections,” Cheulkar noted. “If a disruption is imminent, automated notifications prompt a Ride Health support team to intervene in real time.”

The platform also tracks ride-level performance data and feedback to produce a rating of both the quality of service and the cost of a ride. Real-time geospatial tracking and driver/vehicle identification ensures patient safety as well as compliance with the Office of Inspector General’s Transportation Safe Harbor Regulations, which was very important to Virtua.

MEETING THE CHALLENGE

“We implemented Ride Health in early 2018 as a pilot program for our ED and oncology departments,” Cheulkar recalled. “In its use, our care coordinators enter passenger profiles into the system to streamline the process of creating a ride and to provide a consistent patient experience. Profiles include basic demographic information, home and facility locations, accessibility needs, and communication preferences.”

The platform evaluates the patient profile to automatically identify the right transportation provider, vehicle type and service level for a patient, regardless of physical or psychosocial needs.

“With that basic patient profile in place, a Virtua care coordinator can quickly and easily schedule a ride using on-demand or in advance,” Cheulkar explained. “The platform identifies the right vehicle and driver to meet the needs of any clinical use case – and everything in between. Virtua’s care coordinators receive updates in the system every 15 minutes as Ride Health’s support team proactively monitors each ride while receiving real-time notifications for any necessary interventions.”

Virtua can track ride activity, performance and patient satisfaction to understand progress against program KPIs and take actionable next steps.

“Today Ride Health is a separate platform for which we use single-sign-on,” she said. “But Virtua intends to work on integration with our Epic EHR, and we expect to have that available by the end of the year.”

RESULTS

Since adopting the technology for transportation assistance, Virtua has provided more than 1,000 rides in 2018 and more than 3,000 rides in 2019. First-year results include:

• A more than 50%+ reduction in the average cost per ride, from $42 to $20.
• A 46% reduction in patient no-shows at Virtua Health’s Memorial Radiation Oncology clinic.
• A 75% reduction in patient no-shows for oncology appointments across the Virtua Health system.
• A 20% improvement in inpatient bed availability at Memorial Hospital due to faster ED throughput (the time between arrival in the ED and admission to the hospital).
• A 7-to-1 return on investment overall.

“Additionally, while it previously took between four to eight hours for a cab to pick up a patient from the ED, Ride Health has reduced that time to 10-20 minutes at night and 6-10 minutes during the day,” Cheulkar noted.

“Patients and staff have both been satisfied with the approach. Patients have commented that the transportation has been quick and courteous. We have gathered comments from our staff who have been impressed with the service, how quickly rides arrive, how smooth the process is and how simple it is to use the platform.”

The bottom line, she said, is the platform has been so successful that Virtua now is expanding the program system-wide, including to newly acquired health system hospitals and their outpatient-based providers.

ADVICE FOR OTHERS

“Since our initial adoption of technology to support our transportation assistance program in 2018, we have identified a few best practices for organizations who would like to adopt and implement similar technology,” Cheulkar said, specifying:

1. Develop a system-wide policy based on regulations and procedures to guide operations.
2. Dedicate project management to implement and lead an interdisciplinary team involving IS, operations, legal, administration and financial stakeholders.
3. Training/workshops for super-users, for technology teaching and education about system-wide policy.
4. Staggered rollout of the program to aid in customization of technology for preferred use.
5. Daily auditing to track utilization, validate billing and re-education of users for proper operations.
6. Electronic health record documentation to comply with federal regulations.
7. Single-sign-on for security to aid in monitoring and validating user access.
8. Adopt continuous process-improvement to assist in operational implementation, expansion and sustaining the program.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
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